HomeMy WebLinkAbout224400 09/25/2013 I
CITY OF CARMEL, INDIANA VENDOR: 366748 Page 1 of 1
ONE CIVIC SQUARE AIRGAS USA,LLC
CARMEL, INDIANA 46032 PO BOX 532609 CHECK AMOUNT: $54.09
', odor ATLANTA GA 30353-2609 CHECK NUMBER: 224400
CHECK DATE: 9/25/2013
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
651 5023990 9912449056 54 . 09 OTHER EXPENSES
CYLINDER RENTAL INVOICE
Airgas USA,LLC NVOICE DATE PAYER INVOICE NO. DUE DATE PAY THIS AMOUNT
��( ��. PO Box 9249 08/31/2013 1813998 9912449056 09/30/2013 $54.09
LrL� ` 0 Marietta,GA 30065-2249
• • 1 • AMOUNT ENCLOSED
SOLD BY AIRGAS USA, LLC ❑ Check
5430 W MORRIS ST
INDIANAPOLIS IN 46241-3429 ❑Credit Card
317-243-6606 Please visit www.airgas.com/onlinebillpay or
complete the information on the reverse side of this form.
-PLEASEMAKErCHECKS P;kYAEILIE AND REMIT TO:
11111111'II"111n11,.I.Ilnlll.I,1,I.n'lll'nl'11'11'ullrnl,
T467"AUTO 3-DIGIT 460 PL7 S296 i11111'II"II'11"III11'1'lll'll'll'llll"IIIII'llll'1"1111"II
BILL TO {CITY OF CARMEL SEWER
1 CIVIC SQ AIRGAS USA, LLC
CARMEL IN 46032-2584
y PO BOX 532609
ATLANTA GA 30353-2609
134437
18139981991244905600000054098
------------------- -- ----- -- -. ----- - - "- -- ----- --- ------ --- -------------------------------------- -- --------------------------------------------
TO ENSURE PROPER CREDIT PLEASE RETURN THE UPPER PORTION WITH YOUR REMITTANCE.FOR QUESTIONS ON YOUR ACCOUNT PLEASE CALL: 800-727-0693
s"INVOICE NO.:: :SOLD TO NUMBER_, ..::...SHIP TO INVOICE DATE RENTALRURCHASE ORDER NO. .M. TERMS
99124490561 1813998 1778561 08/31/2013 RENT NET 30
MATEERIALIDESCRIPTION- " §UBJEDT
BEG t3AL SHIP. RETURN ADJ END BAL LEASES NET DAYS- RATE PRICE
=?,.. DOCUMENTTIDATE - i Tp RENT ..
RRCYLISM—AC — Rent Cyl Ind Small Acetylene
2 0 0 0 2 1 1 31 $0.6148/DAY $19.05 N
RRCYLISM-OX - Rent Cyl Ind Small Oxygen
1 0 0 0 1 0 1 31 $0.59/DAY $18.29 N
3 0 0 0 3 $37.34
-----------------------------------------------------------------------------------------------------------
Hazmat: 16.75
Important.See the Notice Regarding Cylinder Rentals/Leases and Responsibility on the 'A,ti 6j T;DUE $ 54.09
Reverse side of this form.You will be deemed to have accepted the provisions in the said
Notice as part of the contractual arrangements between you and us,unless you reject such .
provisions by written advice to us within(15)days after the date of this document.
SHIP TO:1778561
CITY OF CARMEL SEWER AIRGAS USA,LLC
l 0 www.airgas.com 130 1ST AVE SW Acct No.8606074182
Airgas USA,LLC
CARMEL IN 46032-2009 PNC Bank,ABA No 031000053
PO Box 9249
Marietta,GA 30065-2249
REV 1.1.13 SEL-001000 Page 1 of 1
VISA MASTERCARD DISCOVER AMEX Exp. mm/yy_.
Card #
Print Name
Card Billing Address
Card Holder's Phone Number
Signature
If you are faxing this form please provide your Airgas acct# and Invoice#
froat the re,.erse side.
�
Disclosure
Terms of Sale: i-ach safe.of Goods or ervices by an Airgas'� company is and shail be governed by the t:,rrns and conaitions L,.this Disclosure,the �---,rms of Sale affixed
� _the Account—'Application.(if one_has_-~.~~~`.and the Terms~.Sale found.^ �
Ea�l)Cantrart In-the sa+m Goods��vice,,-.between Solhr and Buyer Terms of Sale,togeih,,r with any other material describing tne
Goods or"er,ic(.^being Sold,their pri�",delivery iand u/other*xxia,pmwxms, "Gavds'refers'u any ue* ofmn m*/emom//mvex uu`.aeouurvc^mu �
or otherwise nn^wouuv Seller toBuyer.
Notice nn/oumumeo/s»o»ame�m/number o/qmunsu`amouwb./'e,v.e_cvonuem°ucxsa/v/ has�n�o,'
leased too,jy(.,r and which Buyer has not returned)according mSeller s records a,,of the month end of cylinders thus cnarged to Buyer stiall
c,.mmai edcon,f for a'�moi-�pvseoloetwpanovv''and Seller,unless o",re,reports m Seller/r writing any e `*,ma/mv within soo�.o after the date xorp`/
m pay rent m all cylinders cha'm".to Buyer until avYO,I�ao either(I)returned�ch cylinders u Seder/^good working wi(x�pays Seller r^ �
Refillable refrigerant wlin*er»m`u:mmn/nmeproperty mxirga or its third-party vemor!�, Such cylinders vmm not oe used u �
Customer for pumoses olhor than m of r as products pUrchased from Ai m the return and reclamation of certain gases(e.o,refrigerants) sa'mmm/ame
qovyerw.oua`!�Jrutmorr/nue,d^:^sxfne..mestam/ux^A,y Aima^from time'utime. Airgos will nuvrm the deposit fee m`r^the Customer emons the ren t
vylio °,"nlesso.00v^"mor�s"mndition."ueoneumuevnm:ormvve,usumonn/nvuuvAimas,wm.m,om*mo/on,/oou»^x»o/numtau/nmxtyuaymao"rtx^¥oue,wav
returned
� Warrantv. A! of sale cylinders and other containers furnished by an Airgas company shall conform to the description wereo published w "�e
puso
nyo�^a�umrs''*'.�,�w.`,unow,'meet Saxo/` m`oonsxroo products. SELLER upEcmcALc/omCuv/Ms ANY OTHER EXPRESS on/m �
arAwoxxou �u^w�mrsea on �^^en�mnss /mo�umws�wvvw�nn�wnsnopm�ncx^wn^amr( �/rweaarom� pxnr/ou�«epun�oeeonwnw
' ' ' ' ' !
/wpmwasmEwrAwoAmvwmnnAwnEorxxrmw/asALLsosoro^mmsAaxneouoopounroMonunxoE.
SELLER SHALL BE LIABLE ONLY FOR THE REPAIR OR REPLACEMENT OF DEFECTIVE GAS CYLINDERS AND PRODUCTS,INCLUDING
THE REIPLACEMENT OF GASES THAT DO NOT MEET ITS PURITY SPECIFICATIONS WITH GASES THAT DO MEET SUCH SPECIFICATIONS. BUYER KNOWINGLY
AND puLc/xrnuMsn THE mpns OF rnmvmponz/wn AND us/wo oomrnsSsEo sAasa scusn soAu NOT BE LIABLE FOR ANY DIRECT(EXCEPT xs
sxpnsosu/peovmen*sns/w), wumsoz opscmL. /womEwrAL.CONSEQUENTIAL AND/OR pummvs oumAaao.Ammwe OR ALLEGED TO ARISE oyr
OF OR IN CONNECTION WITH ITS PERFORMANCE OF ANY OBLIGATIONS ORANY PRODUCT,OTHER ITEMS OF SALE,OR EQUIPMENT SOLD OR LEASED BY
SELLER,WHETHER SUCH DAMAGF RESULTS FROM ANY NEGLIGENT ACT OR OMISSION OR IS RELATED TO STRICT LIABILITY,OR OTHERWISE.
| av�,wmo"mker*vmot',mx�m�oo.mv uo��eua��ap�r �,�c� oon ^�dwmnx�omn�mt
/` to o'.�,,sa�;'amm`ontmu,,v,'so^a"c/;,� m,m'r^^ano°,utym pay, ' /ampayment a`n of 1swvnmeun{m'o,past due balance,`vmuo assessed moo�'`'v
hwan"n two m,/am(ou.uu).o the nmanmm lawful I ate ov'iwamw.o the state where[tie Goods are delivered.°hxmeversmss.
Llhoo notc,,�,nd fe.Ceif,l Of UndeiIyiny JOCILIcliowailion,Buyer Shelf pa/to Sellet a surch /g, /n the event of any"^nommn,/otomem'crmo.o�ise m the
""u
of(a)power anc!;u raw materials used m the production m Products andxxy4fuel.
� JjUvto Eguutpff~�J: Title m all rental°:v/pw*w shall pm°/^msexe/^name. sv/er shall not cover,noo*»mn',*mormrm:.wmmum any m*"m=unnmmxe'mmm"m
�
Seller's ownership unonvreotal,nu/nme t.
ZaKues: Any:.v*`imposed ovfedom..slaw,u'other omuo`meo/u/authority un ^e sale.use orpomm.wo"m Goods,ml,o sale o,pemxmanck.'«services uvan^,�,s
ccnpan/uhal/be paid by Buyer m addition m the purchase price.
fa z
ed_Charg^x <a>rxe tnI:a:"n`�ivntdue from the aL^o,mar no|"dv,axnvs itemized charges.mciuo`m� c^n�eov.'mo »uocnno of��z�ovsnaer^ls an':'a
ccn,plia":ew-Ix laws unuxm"'aowuconce°om hazardous materials:charges for handling,delivery aid Shipping:u"mo,o^argc xx energy mfuy.None u/the uw':l,s
nta ~'fee `om �oo,/.r/'`oeou%,^nvnovom'`ro'authority, and al'ur the charges are, �mmor �/the oe||p' "The S+/l,,has no ,r*^mm',vop"x/.ncl^^o
m-umms vus�ecn the mmrcw arc mm actual costs aysocm,qwxh the charges,=mu can vary b� product,"e=icv nn-c�and pla.u,v,,mng mv,"`
c:,mo,;noto/-eouvnm,meum'/ra Rider�,/uo/mpuse1 Without mutual consent.
G,,�,,Q.ruorezit C«�ioor'a-t A'.g,,/companies are u.S.jvvornimnonc[o.o and m/uwnl,ae^,"and ate a.bleum,,d,axr^-,�,.ixrre./. ano",^,'/ede,a'�.`�
�,nuomvrdpi,-a'm rules unurcuu'uoo,a,spw:/cnxvFzs"n.eore.(,-'No. n2*s. the ne`"um/uoon Act^r,y13 and !he*m^o^` p',vea.v``ned)oSI`,",
ru/ 1974 v/'aampi..a/
Airgas eBLIsiness
| /"n°u".voo"s`.auo won mmpcmv^.e,mo'.over with v". ouusinu*xwabmte.xmn://wwwn/m,s`vm. Visit ua online ucu'ms�em how°www.v�ma .u"m can Save V"u
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time and money.
Prescribed by State Board of Accounts City Form No.201 (Rev 1995)
ACCOUNTS PAYABLE VOUCHER
CITY OF CARMEL
An invoice or bill to be properly itemized must show, kind of service, where
performed, dates of service rendered, by whom, rates per day, number of units,
price per unit, etc.
Payee
355856
AIRGAS USA, LLC Purchase Order No.
PO BOX 532609 Terms
ATLANTA, GA 30353-2609 Due Date 9/18/2013
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
9/18/2013 9912449056 $54.09
I hereby certify that the attached invoice(s), or bill(s) is(are)true and
correct and I have audited same in accordance with IC 5-11-10-1.6
9/"
Date Officer
VOUCHER # 136425 WARRANT # ALLOWED
355856 IN SUM OF $
AIRGAS USA, LLC
PO BOX 532609
ATLANTA, GA 30353-2609
Carmel Wastewater Utility
ON ACCOUNT OF APPROPRIATION FOR
Board members
PO# INV# ACCT# AMOUNT Audit Trail Code
9912449056 01-7362-06 $54.09
i
i
Voucher Total $54.09
Cost distribution ledger classification if
claim paid under vehicle highway fund